Traditional MedicareAdministrativeLow impact
Newsletter Vol. 19, No. 14
New Jersey Medicaid·NJ·Provider Notice
Effective date
May 1, 2009
We identified it
Jun 20, 2026
Summary
New Jersey pharmacies must submit Medicare Part D claims first before requesting co-payment reimbursement from the state for dual-eligible beneficiaries. The state covers co-payments of $1.10/$3.20 or $2.40/$6.00 based on the beneficiary's Low Income Subsidy level, and pharmacies cannot collect co-payments directly from these patients.
Action Required
Immediately: This policy applies only to New Jersey pharmacies dispensing prescription drugs to dual-eligible Medicaid/Medicare beneficiaries. Medical billing teams at physician practices are not directly affected by this pharmacy-specific policy change regarding prescription drug co-payment processing.